Behavioral Health: Cheaper Than Disease

Time Magazine has a blockbuster special report out this week by Steven Brill, entitled Bitter Pill: Why Medical Bills Are Killing Us. I recommend you bookmark it now, and read it when you have a couple of hours to spare. It's long- very long. Its length is more than justified, however, by the importance and complexity of the subject it covers.

A few years ago I cut myself deeply and had to go to the ER. It was a routine visit, I just needed stitched up and sent on my way. I got a bill, and it was high, but not outrageous. I was fortunate to have good insurance, so I was not too worried, because outside of my $100 ER copay, my insurer picked up the tab. But I did look at the bill. One thing I noticed was a $4.00 charge for Ibuprofen- 800 milligrams. I thought to myself- "this has got to be a big part of why healthcare is so dang expensive in this country".

Essentially, that story is the premise of the article. Brill breaks down the itemized bills of 7 different patients, and tries to get at the root of why things cost so much. In the process, he finds standard practices of double and even triple billing, 400% markups (or more!) on devices, procedures and lab work, and pharmaceutical costs that are higher in the US than anywhere else in the world- and extend well beyond "research and development costs". He finds that non-profit hospitals are generally more profitable than for-profit ones, and that the bills for uninsured people who cannot afford care are higher than the bills for those with good insurance who can. Really, read the article.

The major problem with the cost of medical care is that it is generally required. When you need care, you need it. As a consumer, you are in a really, really poor bargaining position. Do you want this potentially life-saving care or not? If so, pay us what we are charging you. You want this drug that will dramatically increase your quality of life? It costs a third of your monthly income. If we can, we are willing to pay it, because it is so important. The problem is that all the links in the food chain know this as well, and they all add their own sizable markup into the final cost, knowing full well that it is the ultimate seller's market.

And, at the end of the day, thank God for modern medicine. When my young son was hospitalized with pneumonia, what a blessing that he got such great care at the Children's Hospital. When my dad got a pacemaker, it was truly something to be grateful for. The fact that there are costs associated with these miracles is an inevitable truth. But are the astronomical costs always warranted? This article presents a powerful case that they are not.

In the meantime, though, this is how it is, and we consumer citizens are pretty powerless. There is nothing else in modern life that will put you into astronomical debt and financial ruin quicker than a medical event. There will always be accidents and diseases that are beyond our control. But the best thing we can do to limit our exposure to the behemoth of the medical-industrial complex is to fastidiously safeguard our own health.

While our ability to control for all aspects of our health is limited, it is something we can influence. Genetics are what they are, of course, and our environments are sometimes pretty unhealthy. However, there are lifestyle adaptations that we can make that are likely to make a significant difference in our vulnerability to many, many major (expensive) illnesses. As I've discussed elsewhere, there are five major categories of lifestyle factors that most impact wellness:

Robust engagement with these five variables can be protective against a lot of illnesses. They aren't perfectly effective, of course, but they help, and they have the distinct advantage of being largely under our control. Sadly, while they are behaviors that we can choose or not, they are often very difficult to control, especially in the context of busy and stressful modern lives.

Often psychological processes impact these variables negatively. We might use food as a means to avoid difficult emotions, or we may skip the gym so as to not come into contact with experiences of inadequacy or self-judgment. It is really common to react to a perception that one is impoverished for time by eliminating adaptive behaviors that help manage stress and remain rested. Never mind that this often leaves us less productive and our lives more chaotic- it can give us the feeling of being in control, even when that comes at the expense of actual control.

That's not to mention the ways in which our social relationships can fray and become strained. Maintaining healthy social relationships is vital to both mental and physical health, and often our family histories, stress levels and entrenched patterns of behavior wreak havoc in our social lives- among friends, families and colleagues.

These are not just things that happen to "some people", as we're often led to believe, given the treatment of psychological health by the popular media. These are struggles that hit home for folks in all walks of life, from the high-strung type-A executive to the line worker at the local plant, from the soldier to the stay at home parent. Life often throws more at us than we believe we can handle, and we adapt in ways that are ultimately unhealthy. This tendency is not bound by socioeconomic status, race, gender or nationality. It is human.

Paying attention to behavioral health is vital if one is to succeed in managing the lifestyle factors that are influential in either causing or protecting against illness. Sometimes, that may mean getting help from a qualified professional- a licensed counselor, psychologist, marriage and family therapist or clinical social worker. Certainly, these professionals are not your front line when you get sick- thank goodness for Docs and hospitals- but they can play a key role in helping to prevent you from getting there in the first place.